128 Main Road
Hermanus
7200
Tel: 028 312 1277
Fax: 028 312 1277

PATIENT REGISTRATION FORM

 
To speed up the Administration process when you arrive at the practice, please complete a Patient Registration Form.

Two options are available.

Click here to print a copy of the form.
Once complete, fax the form to us.
Click here to complete and
submit the form from your computer.

ONLINE APPOINTMENT BOOKING

 
Please fill out our online appointment booking form, entering the date and time that you would like to have an appointment. We will then get in to contact with you, using either the email address or phone number entered on the form to confirm the appointment booking or to arrange a booking at an alternate time.

PLEASE NOTE: We cannot guarantee that an appointment will be available on any particular date and time. Your appointment will only be valid after you have received confirmation. If you do not receive confirmation, please call us on 028 312 1277 to arrange the appointment personally.

SUBSCRIBE TO OUR NEWSLETTER

 
Sent out once a month, our newsletters will keep you up-to-date with the world of optometry, rounding up our latest specials and promotions and everything else you need to know.

To subscribe to the newsletter, just fill out the form with your details and we will add you to our mailing list. They're completely free to sign up to and you can unsubscribe at any time (there's a link in every newsletter).